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Procedure Sprague–Dawley rats weighing 150–200 are anesthetized by i.m. injection of ketamine (40 mg/kg) and droperidol/fentanyl (Inovar) 0.25 mg/kg. Through a 6-cm midline incision in the abdominal wall, the small bowel and cecum are lifted and placed on saline-soaked gauze sponges. The exposed right kidney is dissected from the retroperitoneal area and the vascular and ureteric pedicles ligated with 2–0 silk sutures, transected, and the kidney removed. The renal artery of the left kidney is dissected into the hilum to expose the three main segmental renal arteries. The kidney is not dissected out of the peritoneum. The anterior caudal branch of the artery is then temporarily ligated to establish the volume of renal tissue supplied. The area of ischemia becomes demarcated within 10–15 s. If this approximates 1/4–1/3 of the kidney, a permanent ligature is placed. The viscera are then carefully replaced in the abdomen and peritoneum and linea alba closed with a continuous suture. The skin is closed with stainless-steel clips. Blood for serum creatinine is collected by retro-orbital puncture under anesthesia at various time intervals up to 12 months. In association with this, 24-h urines are collected for measurement of creatinine, protein, and specific gravity.

Introduction: Determination of blood flow in the intracerebral collaterals is an essential step to investigate the effects of experimentally increased fluid shear stress (FSS) on the growth of cerebral collaterals in small animal models. Thus, the aim of this study was to establish the quantitative MRI-based flow measurement using the example of the rat circle of Willis. Materials and Methods: To increase blood flow in the rat circle of Willis we developed two different models. In the Solo-Shunt group the common carotid artery was anastomosed end-to-side with the jugular vein, thereby creating an arterio-venous (AV) fistula on the left side (n=10). In the Ligature-Shunt group AV fistula-creation on the left side was performed additionally to the ligature of the right common carotid artery (n=10). Blood flow changes were monitored by a MRI-Scanner (Bruker PharmaScan 70/16–7.0 Tesla; (300.51 MHz; 16 cm) 1 d, 7 d and 14 d after surgery under controlled isoflurane anaesthesia. First a coronal three-dimensional phase contrast angiogram of the whole rat brain was performed to detect the circle of Willis. Then, three points in the maximum intensity-projection (MIP) of the angiogram were selected, which were situated on a straight part of the target vessel, the A. cerebri prosterior. The connecting line of the two outer points defined the normal of the new slices and, consequently, the new slice angels, the included third point defined the position of the following flow quantification sequence. The calculation of the physical coordinates from the image points and the sequence parameters as well as the calculation of the parameters of the new slices were done with a program written by one of the authors. The maximum velocity encoding (venc) was adjusted to the expected flow in the target vessels. Usually, a venc of 50 cm/s was used. The quantitative flow values (ml/min) were then obtained by integrating across manually drawn regions of interest (ROI) that enclose the vessels using Paravision 4.1 ROI-Tool. Results: MRI-based flow measurement could verify the functionality of the fistula in both groups (Solo-Shunt: 3.28±1.34 ml/min, Ligature-Shunt: 1.37±0.61 ml/min). Flow quantification showed a significant increase of blood flow in the circle of Willis (preoperative: 0.48±0.36 ml/min): 0.83±0.26 (1 d); 1.76±0.41 (7 d); 2.06±0.83 (14 d) and sham-side (ml/min): 0.35±0.20 (1 d); 0.44±0.14 (7 d); 0.53±0.37 (14 d). Ligature-Shunt: fistula-side (ml/min): 1.18±0.10 (1 d); 3.60±0.59 (7 d); 4.95±0.45 (14 d) and ligature-side (ml/min): 1.06±0.20 (1 d); 2.38±0.38 (7 d); 2.61±0.70 (14 d). Conclusion: The combination of a phase contrast angiogram and a calculated flow quantification sequence provides via the Bruker PharmaScan 70/16 the possibility to determine the blood flow also in small, intracerebral collaterals The blood flow in the circle of Willis can be significantly enhanced by the creation of a carotid-jugular AV fistula.

Purpose: Various methods for murine pancreas transplantation using suture techniques have been described. However, severe technical problems have limited its widespread use. We therefore designed a new surgical model for cervical heterotopic pancreas transplantation using a cuff technique. Methods: Recipients were intraperitoneally injected with streptozotocin (STZ) in order to become hyperglycemic (blood glucose > 300 mg/dl). Recipient operation: The right external jugular vein (EJV) and common carotid artery were dissected free. By using a polyethylene cuff it became possible to evert the artery over the cuff body and finally fix the vessel with 8-0 silk ligatures. Similarly the EJV could be everted. Donor operation: After a complete midline incision the pancreas was isolated using a no-touch technique on a segment of the aorta (AS), including the celiac axis and the superior mesenteric artery. The venous outflow was provided by the portal vein (PV). Implantation: The graft was placed in the right cervical region and vascular anastomoses completed by pulling the PV over the EJV-cuff and the donor AS over the carotid cuff and held in place with a 8-0 silk ligature. After releasing venous and arterial clamps, all grafts immediately returned to their normal pink color with the arterial stump pulsating. To test applicability of this model graft microcirculation was evaluated by intravital microscopy following prolonged cold ischemia (16 h). Results: More than 90 % of the recipients survived. Donor operation lasted 40 ± 5 min and dissection of recipient vessels 20 ± 4 min. Implantation time was 4 to 6 min, resulting in a total pancreas ischemia time of 33 ± 6 min. No thromboembolic complications at the cuff side were observed. Preoperative glucose levels were 518 ± 59 mg/dl and could all be normalized by p. o. day 1 (88 ± 13 mg/dl). Histology on p. o. days 10 and 30 showed almost normal islet cell and acinar architecture of all grafts. In groups with prolonged cold ischemia graft microcirculation was significantly reduced paralleled by increased inflammation, interstitial edema, haemorrhages, acinar vacuolization and focal areas of necrosis compared to non-ischemic controls. Conclusion: For the first time a method of cervical heterotopic pancreas transplantation using a non-suture cuff technique in the mouse is described. Major advantages are a short ischemia time, lack of arterial thrombosis or venous stenosis and short operation time, and thus a very high survival rate. This model is especially applicable for investigating preservation, reperfusion injury and graft pancreatitis.

Prospective in vivo experiments to test the morphogenic power of increased fluid shear stress on collateral vessel growth (arteriogenesis) are rare. Therefore, the present study was designed to determine the arteriogenic potency of increased fluid shear stress and elucidate the underlying mechanism. Methods: Domestic pigs (n = 20) underwent bilateral proximal ligature of both superficial femoral arteries. At 1 week, a side-to-side anastomosis was created unilaterally between the distal femoral stump and the accompanying vein. Another week later, pressure and flow measurements in presence and absence of reactive hyperemia were performed to determine the fractional collateral flow (FCF). Quantitative arterial angiography was utilized for morphometric analysis of the collateral vessels. Subsequently, the vessels were excised and confocal immunohistochemistry (PCNA, eNOS, a-actin, lectin), as well as 2D-PAGE, differential expression analysis and Northern-blotting for destrin, cofilin-1, cofilin-2 and transgelin-2 was performed. Results: The number and size of collateral vessels was significantly increased in the shunted (S) as compared to the non-shunted (C) limb (p < 0,001; t-test). The mean fractional collateral flow was also significantly elevated (p

Laparoscopic surgery is becoming increasingly important, and this also holds for children. However, the instruments are still of a very large caliber for application in the neonatal period and early childhood, particularly the clips, clip forceps, ligature loops, and diathermy forceps required for hemostasis: this is obstructive and limits indication.

Ascending varicophlebitis can cause pulmonary embolism by entering the deep venous system. Classification into four stages permits a differentiated therapeutic strategy: if the thrombus reaches or enters the deep venous system, immediate surgery consisting of crossectomy, resection of the saphenous vein, radical excision of all varicosed veins and ligature of insufficient perforating veins are indicated.

Carcinoid tumors are very rarely seen. We have treated 10 patients with carcinoid tumors in the last 4 years. We used arterial chemo-embolisation, embolisation, hepatic arterial ligature and a drug therapy with octreotid and interferon alpha after the resection of the primary tumor.

W(illiam) H(arvey) shows by the way the heart is made that the blood is perpetually driven from the lungs into the aorta…. He shows by means of a ligature the passage of the blood from arteries to the veins. Hence it is demonstrated that the perpetual movement of the blood takes place in a circle, owing to the beat of the heart (Lumleian Lecture to the College of Physicians in London on April 17, 1616).

Advances in minimally invasive techniques have led to a continuous expansion of the diagnostic and therapeutic indications for thoracoscopy. For example, fibrin glue is now being used in various novel ways. We present our experience with tissue adhesives in thoracoscopy. Between January 1990 and October 1992, 287 videothoracoscopies were performed at the Department of Thoracic- and Cardiovascular Surgery, University of Bern and the Limmattal Hospital in Schlieren-Zurich. Fibrin glue was used 45 times. In patients with diffuse pulmonary pathology, the operative field was sealed with fibrin glue after extensive biopsy: six times after wedge resection and seven times after tissue ligature. In eight patients, fibrin glue was injected under the surface of the biopsied area after sharp dissection of the lung parenchyma. In all cases an airtight seal was achieved. After biopsy of a mediastinal tumor, hemostasis was successful after injection of fibrin glue. Fibrin glue was used in 11 patients with postoperative bronchopleural fistulas. Definite closure was achieved in 8 of these cases. A postoperative thoracic duct leak was sealed with fibrin glue. Endoscopic fibrin pleurodesis for malignant pleural effusion was successful in 7 of 11 patients. In summary, fibrin sealant was successful in 38 of the 45 cases (84.4%). There were no intra- or postoperative complications which could be attributed to the use of fibrin adhesive. In particular, there was no incidence of pleural infection or allergic reaction.

Chylothorax may be a rare problem in thoracic and cardiovascular surgery, but it is one which is often difficult to handle. The therapeutic procedure required in each individual case is determined by the anatomy and physiology of the ductus thoracicus and the individual etiology of the chylothorax. The ductus thoracicus runs from the cysterna chilii through the right hemithorax in a dorsolateral position relative to the hiatus aortae, crossing over to the left at the height of the fourth thoracic vertebra and passing to the left supraclavicular venous angle. Major pathogenetic features of the duct are its variability, the large number of collaterals, and the variety of lymphaticovenous anastomoses found. Lymph flow at peak pressures up to 25 cm H2O is tolerated; at higher pressures the duct or its collaterals rupture. In terms of etiology, two groups may be distinguished: (a) traumatic or iatrogenic causes, i.e., direct punctual lesions, and (b) chylothorax of neoplastic origin, caused either by direct destruction by the tumor or by ruptures of the collaterals or intrathoracic lymphaticovenous anastomoses due to increased intraductal pressure. The absolute incidence of chylothorax remains at a constant low level. Over a period of 20 years the Mayo Clinic reports only 53 cases; at our clinic we have treated a total of 9 cases in the past 10 years. Our therapeutic approach, which is based on pathophysiological and anatomical considerations, is as follows: (a) Primary attempt at conservative treatment: parenteral feeding with a fat-free diet using a gastric tube (!) to relieve the stomach combined with Buelau drainage with a low suction. (b) In the case of traumatic or operative/iatrogenic chylothorax, the direct suture or supradiaphragmal ligature (Lampson) may be used; the possibility of the complication of chyloperitoneum must, however, be considered if there is a lack of collaterals. (c) In the case of severe localized obstruction due to tumor growth, relapse due to increased pressure in the collaterals is very probable. In such cases it is better to cover the rupture directly with autologous or xenogenic material and to seal it with fibrin glue. Fibrin glue appears helpful in providing an absolutely tight seal against fatty fluids in the area of the leakage for 1–2 days until the area is further sealed by cicatrization due to incipient healing and conversion processes. We see our concept as a promising additive to surgery, which can reduce the complication rate in the case of chylothorax caused by tumors with high secretion rates.

According to Dolenc [9] Mont as early as 1935 advocated in cases of carotid- cavernous sinus fistulas (CCSF) with anterior drainage through the superior orbital vein (SOV) the resection and ligature of this vein. He suggested scouring the lumen with a small tube brush soaked in 50% glucose. Also, as described by Dolenc, Brainerd in 1953 attempted to cure an “erectile tumor of the orbit” by retrograde injection of lactate of iron. Dandy et al. in 1937 [3] and 1941 [4] expressed the opinion that the SOV route should not be used for treating CCSF. In 1975 Peterson et al. [11] used a percutaneous approach for passing through the SOV to treat successfully CCSF. In 1981 Debrun et al. [6] maintained that the endovenous route was an excellent way to treat CCSF drained anteriorly through the SOV; however, their first percutaneous approaches failed, and in 1983 [7] Debrun wrote that “retrograde navigation through the SOV was virtually impossible in cases of CCSF with totally or mainly anterior drainage through the ophthalmic veins.” But they were recently successful [8], in two cases using a surgical approach. In fact, Uflacker et al. [13] in 1986 published the most important article on retrograde catheterism through the SOV for treating CCSF drained anteriorly, presenting three successful cases out of five by a surgical approach “deep in the orbit.” Since this article, very few cases of CCSF embolization through the SOV have been published. Here we present four such cases, coming from three different French neuroradiological and neurosurgical teams.

The vessels from which catastrophic haemorrhage occurs in head and neck surgery are the carotids, common and internal. Haemorrhage from these vessels is liable to be fatal not merely as a result of ex-sanguination, but because control of the bleeding by clamp or ligature, the methods likely to be required in the typical emergency situation, affects the cerebral circulation, frequently resulting in hemiplegia with a fatal outcome in a percentage of patients. The risk of haemorrhage is greatest following pharyngeal surgery and two striking aetiological factors are recognised - exposure of the vessels and damage to the vessel wall. The vessels become exposed as a result of wound breakdown or tissue necrosis. Exposure of the healthy carotid is remarkably well tolerated and it rarely if ever ruptures. It is the vessel in the neck which has previously been irradiated which is at risk (Marchetta et al. 1967). Breakdown of the neck wound is more likely and rupture of the exposed vessel becomes then a very real hazard. Exposure is most likely to be followed by rupture when the time lapse between radiotherapy and surgery exceeds 6 months (Briant 1975). Radiotherapy followed by elective surgery does not constitute the problem; it is the uncoordinated use of radiotherapy followed by salvage surgery which accounts for most carotid ruptures (Joseph and Shumrick 1973).

The operation method preferred in therapy of idiopathic varicocele in recent years is increasingly the suprainguinal ligature of the v. testicularis, as described first by Bernardi in 1941. Postoperatively, a recidivation of the varicocele or a persistent varicocele can be expected in more than 10% of all cases. The reason for a persistent varicocele in more than 90% of all cases is an incomplete ligature of the branches of the V. testicularis. To reduce this high rate of failure some authors principally demand phlebography before every operation of varicocele [2]. It is questionable, however, if this step can achieve a reasonable reduction of the failure rate, because in phlebography smaller branches of the v. testicularis responsible for the persistence of varicocele cannot be shown in all cases. A much safer method to reduce the high failure rate of more than 10% is to ligate the vasa testiculares completely. This operation method, which was first described by Palomo [8] in 1949, in our opinion, has been wrongly brought into discredit. It is true that an additional ligature of the a. testicularis is not necessary for a good postoperative result [3]. In most cases, however, ligation of the whole vascular bundle of the a. and v. testicularis can prevent the recidivation or persistence of the varicocele after high ligation of the v. testicularis. This can be concluded from the fact that the v. testicularis in 70% of patients consists of two or three veins above the inner inguinal ring [12]. Additionally, in 30% of cases the v. testicularis has a double, in 3% of cases a triple, orifice at the left v. renalis [12].

The use of penile prostheses is the oldest and best-known treatment of erectile dysfunction. In the last few years, alternative methods have been presented, i.e., self-injection of the corpora cavernosa with vasoactive drugs, ligature of the penile deep dorsal vein, and bypass operations to improve the arterial blood supply to the penis. Although increasingly popular, these alternative methods have not been able to reduce the number of prosthesis implantations in the long run. After a short initial drop, the implantation rate is again increasing worldwide. This is due to critical reports on the alternative treatments.

Acrylamide given to rats after damage to the posterior tibial nerve by a tight ligature causes retrograde degeneration of axons. The number of fibres affected and the extent of degeneration towards the cell body are dose dependent The effect is the same whether the acrylamide is given immediately after ligature or one week later. The degeneration is delayed several days after giving acrylamide. Before axonal disintegration occurs, focal accumulations of SER, vesicles and multivesicular bodies are seen beneath the axon membrane. Associated with these changes larger vacuoles occur, either in the axon or external to it It is suggested that these early changes are a response by the axon and perikaryon to the local metabolic damage caused by the toxic chemical. Somewhat similar changes also occur in early predegenerative INH intoxication, and before the axon degeneration in O-P neurotoxicity.

Intramedullary spinal angiomas fed solely or partly by the anterior spinal system have been considered for many years to be not amenable to surgical treatment. Only posterior retromedullary angiomas were operated upon and totally removed. Anterior spinal malformations were sometimes attacked indirectly by intradural ligature of an anterior feeding vessel, especially in the cervical area. However, these surgical attempts were only palliative treatment. Percutaneous embolization was a useful complement to surgery but was not always possible and could not achieve a radical cure for anterior spinal malformations.

In 1893 the Paris correspondent of The Lancet referred to a presentation by M. Pavlow, as follows: “If (sic), by means of a ligature placed on the portal vein (sic), the blood is compelled to deviate from the liver and pass directly into the general circulation, poisonous symptoms appear, consisting of fever and nephritis, with albuminuria. That this nephritis is not due to hypertension of the blood in the renal vessels is proved by the fact that no such kidney trouble is caused by ligature of the inferior vena cava although this manoeuvre is productive of a greater tension in the renal vessels than the operation inquestion.

Certain anatomical characteristics peculiar to the gerbil make it the animal model best adapted to experimental pathology studies of acute ischaemia. In this animal species, devoid of any substitute vertebro-basilar vascular tissue, unilateral ligature of the carotid artery produces a cerebral ischaemia with neurological signs (well quantifiable), metabolic perturbations (especially mitochondrial) and cerebral oedema development closely resembling the symptoms revealed by physiopathology in human clinical studies. Using this model and under the experimental conditions described, clear-cut, highly significant results were obtained with Ginkgo biloba, whether by oral or intravenous administration. These results were normalization of mitochondrial respiration, diminution of cerebral oedema, correction of the accompanying ionic perturbations, and practically total functional restoration revealed by a normal neurological index in the gerbils treated with Ginkgo biloba extract.

The management of uncomplicated esophageal atresia is a straightforward procedure consisting of thoracotomy with anastomosis of the atretic segments and ligature of any tracheoesophageal fistula present. However, besides the rareness of isolated esophageal atresia, our observations in the past few years show increasing incidence of the anomaly in association with premature births and other malformations which are usually incompatible with life. Aspiration pneumonia resulting from reflux of gastric content through a lower tracheoesophageal fistula, rather than the overflow of saliva from an upper atretic pouch, also threatens the life of an otherwise healthy neonate with esophageal atresia.

Recent reports have shown that the effect of nerve trauma on the axonal transport of acetylcholinesterase (AChE) may differ depending on the type of injury. While the axonal transport of AChE was seen to decrease drastically during the 2-3 days following nerve injury, whatever the injury [3, 5, 7], the recovery which followed this initial drop was seen to take place only after nerve crush [5,7] or nerve freezing [5] but not after nerve section and very little after nerve ligature [5].

MORDUE has stated (Gen. Comp. Endocrinol. 9, 406–415, 1967) that in T. molitor females, midgut proteolytic activity is regulated via the median neurosecretory cells of the protocerebrum. The aim of this work was: (1) to study whether or not the amylolytic activity of T. molitor adults is regulated in a similar way, and (2) to find out if there is some relationship between cytodifferentiation of midgut epithelium and the amylolytic activity. Comparative studies of amylolytic activity, midgut epithelium, and the neuroendocrine system were undertaken. Adults 0–2 h and 18–20 h after emergence were ligated around the head, and others (0–6 h and 18–20 h after emergence) were injected with crude head extract, 10 µl/individual prepared in saline solution from 4–5 day-old, fed adults. Following this treatment, ligated insects were sacrificed after 18 h and 72 h, and the injected ones after 18 h. The results show that in ligated adults the amylolytic activity was decreased, while in recipients of head extract it was significantly increased. The ligature was more effective in older adults, the injection of extract was more effective in newly emerged ones. In older (18 h) insects the old epithelium was replaced by a new one, the number of epithelial cells was significantly increased, and the neuroendocrine system was in a more active physiologic state. In ligated adults (72 h) a decreased number of epithelial cells, their incomplete differentiation, and degenerative changes were observed.

Renovascular hypertension in rats was induced by two different methods, the two kidney, one clip renal hypertension and the ligature of the aorta between the origins of both renal arteries. After unilateral renal artery stenosis no correlation was found between blood pressure and urinary kallikrein activity during the development of hypertension, but urinary kallikrein activity was reduced after hypertension was established.

There are two different tendencies in the surgical treatment of colitis ulcerosa and familial polyposis. The representatives of the first one emphasize the radical surgery above everything else and sacrifice the sphincter muscles, thus eliminating all hope of restoring continuity. The second tendency gives preference to maintaining continuity even on the charge of radicality. The followers of the first tendency accomplished the proctocolectomy with an abdominal ileostomy, those of the second one made an ileorectal anastomosis before performing the colectomy. As a result of the first intervention, the usually young patients became invalids. After the latter operation they were exposed to different complications — recurrence, carcinotic transformation, ligature insufficiency, ascending of the disease. However, their sphincter function was adequate.

The cerebral arteries of 35 human brains were injected post mortally with a mixture of barium sulfate, gelatine and malachite green. The specimens were studied radiologically and macroscopically. By ligature of the Aa. communicantes posteriores the arterial vascular system of the posterior fossa could be demonstrated selectively.

The activity of serum enzymes depends on their rates of entrance as well of elimination (or inactivation). Since previous observations were contradictory, we investigated G.O.T. in the blood of rats following ligature of the left liver lobe and after recirculation; an increase in S.G.O.T. occurred. Following i.v. injection of G.O.T., its excretion via the bile is considerably enhanced; however, only a small fraction of injected G.O.T. can be recovered. Addition of lung slices in vitro greatly increases G.O.T. inactivation. Some implications for the interpretation of S.G.O.T. increase are discussed.

Extracerebral arteriovenous malformations occurring as isolated angiomas of the skull or dura mater (4, 6, 7, 9, 11, 14, 17) can be treated by ligature, complete removal or circumcision of the dura mater, thus presenting hardly any therapeutical difficulties. The angiomas of the orbita can normally be cured by complete removal as well (8).

The most important changes observed in the clitoris during childhood have an endocrine basis and are discussed in the following chapter. Traumatic lesions are seen, however, resulting from the tying of a hair or thread around the clitoris, which becomes reddened, oedematous and considerably enlarged. Since a clear history of the cause of the trouble is unlikely to be obtained, other origins for the enlargement may be suspected : one reported case was originally thought to be a paraphimosis (Brown) and a similar lesion ascribed to riding a bicycle may perhaps be regarded with scepticism (Willan). Careful inspection under anaesthesia will reveal the presence of the ligature, and its removal may be all that is required : advanced necrosis may demand amputation.

The history of Hedrology1 coincides with the history of human civilization. The “fistula in ano” is one of the diseases which have affected mankind of all times; its description, expressed more or less clearly in the various periods, and its treatments (ligatures, incision, incision with previous ligature, two times incision, excision, actual and potential cautery), are elements constantly recurring in all texts of pathology which have reached us.